Learning update: Consultations around sexual health

Discussing sexual health need not be embarrassing for customers if pharmacy teams deal with the topic sensitively, without judgement and from an informed standpoint, says pharmacist Deborah Evans 

The role of pharmacists in providing healthcare advice to our local communities continues to grow, with 31 per cent of people saying that, after the pandemic, they were more likely to visit a pharmacy first before seeking help elsewhere.¹

Now with two brands of progestogen-only pill available over the counter, I expect pharmacy to build on emergency contraception provision and become a beacon for sexual health information and services.

As a pharmacist, advising both women and men about their sexual health has led to rewarding consultations. With continued high cases of sexually transmitted infections (317,901) recorded in 2022 and double the number of unplanned pregnancies from the first UK lockdown,³ it is important for community pharmacists and their teams to be as prepared as possible for any scenario.

Age concerns

The first area I’m going to discuss is conversations about age, keeping in mind two different, specific scenarios:

• Younger people and safeguarding
• Contraception for older individuals.

For younger people (below the age of consent) attending the pharmacy, we have the Gillick competence and Fraser guidelines to help us make judgement calls on consent, understanding and coercion. It is a sensitive subject and not exclusive to individuals under 16 years of age as we need to be aware of people with learning difficulties and others who may be being exploited or abused. These people may find it easier to come to their local pharmacy than go to their GP.

Ensure that your safeguarding knowledge is up to date and that you know what to do if you think there is an issue. Make use of the consultation room and if you have any doubts at all, ask directly. Always follow your intuition.

If something does not feel right, then it probably isn’t. Remember, our role isn’t to judge but serve our customer as best we can, including looking out for their wellbeing and safety. This may mean referring them on to more specialised help and if they are in danger, breaching confidentiality.

When discussing sexual health, it is important to consider whether someone might be at risk of an abusive or coercive sexual relationship.

There are government training guidelines online to help you react in the best possible way in this situation. For example, the Ask for ANI (Action Needed Immediately) codeword scheme has been developed to allow victims of domestic abuse to access support from the safety of their local pharmacy.⁴ Materials are available for pharmacies to promote this scheme.

Talking about contraception with older people who may be approaching the menopause is also important as they may still become pregnant. A customer may come into the pharmacy to highlight issues they are having with their contraception but share symptoms of perimenopause or menopause.

Alternatively, they may talk about their perimenopausal symptoms, which offers an opportunity to discuss their contraceptive needs. Listen carefully to all their symptoms and experiences and be ready to discuss options.

For many people approaching the menopause, a progestogen-only pill may be a suitable option and these are now available OTC from pharmacies. However, individuals may want to consider alternatives and if you are unable to help, direct your customer to their GP or specialist family planning service.

Suitability

If a person comes to the pharmacy to discuss their contraception options, it is important to ask the right questions and obtain a clinical history.

They might be a young person using contraception for the first time and needing more guidance; they might have specific health concerns such as diabetes or raised blood pressure; or they might have a more complex medical history. For example, they may have had cancer or a deep vein thrombosis, which would affect their contraceptive choice.

As healthcare experts, we should feel confident in our knowledge of the range of different contraceptive options available and which methods are contraindicated in certain situations, and feel comfortable to share this information with our customers.

The method of contraception a person chooses is a very personal choice and may change throughout their reproductive lives. Approach every customer on a case-by-case basis.

If sexually active, a person’s sexual health also includes the possibility of acquiring a sexually transmitted infection (STI).

If a customer is looking to buy the morning after pill, ask them about their usual contraceptive options and their suitability for emergency contraception. This is a good opportunity to enquire about their risk of a STI and to recommend a check-up. Approach this topic in a non-judgemental way and raise the importance of regular check-ups as a responsible way of managing sexual health, just as we would have physical check-ups for other conditions.

The availability of the progestogen-only pill in pharmacies also provides an opportunity to discuss this contraceptive option if the customer is currently not using regular contraception.

Dealing with embarrassment

Research conducted by ellaOne in 2018 revealed that 57 per cent of 18-35-year-olds felt awkward and embarrassed when purchasing emergency contraception.⁵ To help relax my customer, I frequently start by explaining that we will supply them with the emergency contraceptive pill unless there are medical reasons why this is not suitable. 

New mothers

Many new mothers, especially when they are breastfeeding, do not consider the possibility of getting pregnant soon after giving birth and this can lead to unplanned pregnancies. If a new mother comes into the pharmacy with her newborn baby, you can lead the discussion onto the subject of their contraception. There are several options available to breastfeeding mothers including taking the progestogen-only pill.

Conclusion

Discussing sexual health need not cause embarrassment and when dealt with sensitively and without judgement, pharmacy teams can offer an important and valuable service. In summary, be open and non-judgemental, considering not just what you say but how you say it. 

We are in a privileged position that means people will share personal details with us and we must treat this information sensitively and with respect. Each person should be treated as an individual and on a case-by-case basis. 

It can take years for an individual to find the right contraceptive method for them, and a woman’s contraceptive needs change throughout her reproductive life. Using open questions beginning with ‘what’ and ‘how’, listening carefully and exploring options already tried and considered, will help you to help them. 

The OTC availability of the progestogen-only pill is a great opportunity for pharmacists to further build trust and help empower women to make the best choices for their reproductive and sexual health.

• Deborah Evans is an adviser for OTC pill Hana.

References

1. PAGB 2021. Coronavirus will change attitudes to self care and NHS use, PAGB survey suggests. 
2. PHE 2021. Sexually transmitted infections and screening for chlamydia in England 2020. 
3. UCL 2021 Unplanned pregnancies nearly doubled during lockdown. 
4. Gov.uk. 2021. Ask for ANI domestic abuse codeword scheme: pharmacy materials. 
5. Pharmaceutical Journal 2021. A third of women too embarrassed to talk to pharmacist about morning after pill.